Dietary Assessment in the Individual with Celiac Disease

Nutrition guidelines for celiac disease, developed by our team of celiac specialist dietitians and gastroenterologists, will soon be published in the Journal of Human Nutrition and Dietetics. Currently, dietitians do not have a standardized set of guidelines for a nutritional and dietary assessment of patients with celiac disease following a gluten-free diet. Our team listed below developed specific recommendations based on our evidence based research and clinical expertise in the field. The paper offers a comprehensive review of labs, dietary review, nutritional markers, physical assessments, quality of life issues, controversial topics, and many others. In addition, we created an assessment tool to measure a patient’s eating behaviors, attitudes, and adherence to a gluten-free diet. 

Our team of celiac dietitians and gastroenterologists: 

Authors: Anne Lee, EdD, RDN, Jessica Lebovits, RD, CDN, and Benjamin Lebwohl, MD (Columbia University Medical Center, New York); Melinda Dennis, MS, RDN, LD, and Amelie Therrien, MD (Celiac Center, Beth Israel Deaconess Medical Center, Boston) Lori Welstead, MS, RDN and Ritu Verma, MD, University of Chicago); Joanna Perl, RD (Vanderbilt Center for Human Nutrition)

Abstract presented at ICDS 2024 in Sheffield, UK (Sept 2024)

Dietary Assessment in the Individual with Celiac Disease

Abstract 

Introduction: Celiac disease (CeD) is an immune-mediated reaction to ingested gluten, resulting in intestinal enteropathy with impaired absorption of nutrients. The only treatment for CeD is adherence to a gluten-free diet (GFD). Currently there is no standardized guidelines on dietary assessment of patients with CeD on a GFD.

Methods: A review of literature conducted between March 2023 until September 2023 of PubMed and Cochrane Library databases, using the search terms: ‘celiac disease and nutritional assessment’, ‘nutrient needs’, ‘nutrient deficiency’, ‘anthropometric measurements’, ‘cross-contact’, ‘quality of life’, ‘anxiety’ and ‘depression’. Original research studies and review articles in adult CeD populations were included. In total, 2167 articles were identified, 341 were selected for review and 190 were selected for inclusion in the study. 

Results: There is limited consensus on the components of nutritional and dietary assessment of patients with CeD who are following a GFD, especially in the clinical trial setting. Based on consensus from CeD specialist dietitians and gastroenterologists, specific recommendations were developed for nutritional assessment and dietary adherence. The assessment guidelines include clinical markers, physical assessments, controversial topics, environmental considerations, and the disease burden. A review of current dietary adherence tools indicated several limitations, thus a simplified tool for assessment of adherence to a GFD was developed based on the nutritional assessment to capture patients eating behaviors and attitudes. 

Conclusion: Despite a limited consensus in the literature, there is a need to translate research into clinical practice, resulting in clear guidelines on nutritional assessment and measuring dietary adherence in CeD.